JP2004500182A - Materials and methods for improved bone-tendon-bone grafts - Google Patents

Abstract

Disclosed herein is an improved Bone Tendon Bone graft for use in orthopedic surgical procedures. Specifically exemplified herein is a Bone Tendon Bone graft comprising one or more bone blocks having a groove cut into the surface thereof, wherein said groove is sufficient to accommodate a fixation screw. Also disclosed is a method of harvesting grafts that has improved efficiency and increases the quantity of extracted tissue and minimizes time required by surgeon for implantation.

Description

[0001]
Background of the Invention
Orthopedic medicine recognizes the great potential and benefits of using bone / tendon / bone grafts to repair frequent joint injuries, such as anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) tears. Is being done. One technique currently used to repair these types of injuries involves surgically reattaching the rupture of the injured ligament. However, this technique is often not possible, especially when ligament damage is extensive. To address the situation where joint ligament damage is high, another approach to repositioning tendons so that support for the damaged knee is enhanced is commonly performed. These conventional approaches have drawbacks, and in most cases, the repaired joint is less flexible and stable.
[0002]
With the recent availability of bone / tendon grafts, the performance of joint repair in severe trauma cases has improved dramatically. Even in cases of extensive joint ligament injury, orthopedic surgeons can achieve 100% range of motion and stability with donor bone / tendon grafts.
[0003]
Despite these benefits being recognized, there are several problems with using bone / tendon grafts. For example, surgical procedures involving the implantation and fixation of these implants can take a long time. Currently, bone / tendon / bone graft shapes must be tailored to the recipient at the time of surgery, which can take from 30 minutes to an hour or more. In addition, the surgeon must provide a means for attaching the implant, which also requires significant operating time.
[0004]
Another problem with the use of bone / tendon grafts is the limited supply. This can result in the patient having to choose a poor quality treatment simply because tissue is not available. Thus, there is a need in the art for a system that addresses this and the above problems.
[0005]
Summary of the Invention
The present invention relates to a novel bone-tendon-bone graft (BTB) that facilitates simpler and more efficient surgery for reconstructing ligaments in a joint. One aspect of the present invention relates to a BTB comprising one tendon and two bone blocks located at both ends of the tendon, wherein the bone block is pre-shaped so that it is uniformly and uniformly disposed within the recipient bone. .
[0006]
In one particular aspect, the invention relates to one or more bone blocks and the one or more bone blocks, wherein one or more bone blocks are cut to provide sufficient grooves to accommodate fixation screws. A bone-tendon-bone graft useful in orthopedic surgery, comprising a tendon associated with a bone block of the same. Alternatively, the present invention provides an orthopedic device that includes one or more bone blocks and a tendon associated with the one or more bone blocks, wherein the one or more bone blocks are pre-shaped as a dowel. Bone-tendon-bone grafts useful in surgery.
[0007]
A further aspect of the invention includes cutting out the first bone plug with attached tendon or ligament; and cutting out the second bone plug with attached tendon or ligament. Are derived from a continuous bone stock and overlap such that a groove is formed in the bone plug that is subsequently cut by the cutting of the first or second bone plug. And obtaining a plurality of bone-tendon-bone grafts as described above.
[0008]
In yet another aspect, the present invention relates to a two-ended tendon or ligament having at least one of one or more bone blocks having a groove adapted to receive a fixation screw and coupled to the tendon or ligament A method of performing orthopedic surgery on a human or animal, comprising obtaining a bone-tendon-bone graft comprising one or more bone blocks obtained.
[0009]
One alternative aspect of the invention relates to an implant comprising one bone block and one tendon, wherein the bone block includes a groove for receiving a fixation screw.
[0010]
Yet another aspect of the present invention relates to a BTB core cutter for harvesting a BTB graft in accordance with the principles of the present invention.
[0011]
These and other advantageous aspects of the invention are described in further detail below.
[0012]
Detailed Disclosure of the Invention
Referring to FIG. 1, an embodiment directed to a BTB 100 that includes a first bone block 110 and a second bone block 120 interconnected by tendons 130, each bone block being pre-shaped as a dowel. It is shown. The term "tendon" as used herein is intended to be used in a broad sense and includes fibrous connective tissue for use in implants, including but not limited to tendons, ligaments and demineralized bone Point to. The term "BTB" or "bone-tendon-bone graft" as used herein refers to a graft implant that includes one or more tendon portions and one or more bone portions. . Preferably, the BTB has been isolated from the knee of the donor. However, one of ordinary skill in the art will appreciate that other areas of the body, such as, but not limited to, the Achilles tendon / calcaneal region or the shoulder region, may recover BTB according to the present invention in light of the teachings herein. It would be easy to understand that it is suitable for In addition to BTB having tendons derived from natural tendons or ligaments collected from donors, other such as, but not limited to, segmentally demineralized bone (WO 99/21515) Examples of suitable implants will also be readily apparent to those skilled in the art. In one more preferred embodiment, one of the bone blocks is from the patella, the other is from the distal tibia, and the tendon is from the patella tendon.
[0013]
Preferably, the dowels are machined over the entire length of the bone block to form semicircular cuts 115, 125 to facilitate placement of the fixation screws. The semi-circular cuts 115, 125 provide grooves for placement of the fixation screws, resulting in a larger contact surface area between the bone block and the screws, thus providing a better connection between the implant and the recipient bone. Useful. The semi-circular cuts 115, 125 provide the advantage of filling the "dead" voids in the holes, as well as the additional benefit of increasing the pull out loads of the bone block.
[0014]
Any fastening method known in the art, including but not limited to staples, buttons, screws and washers, interference-fitting screws, and self-tapping screws, can be used in accordance with the principles of the present invention. In one preferred embodiment, the fixation is achieved by interference and / or self-tapping screws. In one even more preferred embodiment, the semi-circular cuts 115, 125 include a threaded section 135 that matches the thread profile of the fixing screw, thereby further increasing the stability of the fixation.
[0015]
Referring to FIG. 2, three different aspects of the BTB of the present invention are shown. FIG. 2A shows an embodiment including the basic embodiment of the BTB of the present invention. Bone blocks 210 and 220 are in the form of a grooveless preformed dowel and are connected by tendon 100. FIG. 2B shows another version of the BTB in which the bone block is preformed as a dowel with tapered ends. Bone block 212 is a dowel with a tapered region 216 proximal to tendon 200, and bone block 214 is preformed as a dowel with a tapered region 218 distal to tendon 200. FIG. 2C illustrates a preferred version of the present invention having a bone block 230 with a tapered region 239 proximally and a groove 238 located in the bone block 230. This version also includes a second bone block 234 with a tapered region at the distal portion, and a groove 236 located in the bone block 234. The embodiment shown in FIGS. 2B-C is tapered such that implantation into a preformed hole in the recipient bone preferably occurs in the direction of the arrow (see also FIG. 4).
[0016]
Referring to FIG. 3, there is illustrated a donor region 300 from which three separate grafts 335, 345 and 355 have been harvested. As shown, the three different implants each have at least one bone block 330, 340 and 350. The order in which the grafts are harvested is not critical, but it is preferable to cut the graft 335 first, followed by the outer grafts 345, 355. The first cut of the graft 335 automatically cuts other donor regions, thereby creating grooves in the other graft bone blocks 340, 350 when cut. In one preferred embodiment, the donor region is located at the attachment of the patella tendon 320 at the top of the tibia. In one more preferred embodiment, the donor region extends beyond the patella tendon to the patella, and the bone block is cut from the patella.
[0017]
Bone blocks can be removed using common instruments and procedures routinely used in the art, such as core cutters and perforators. In one preferred embodiment, a bone block can be removed using a BTB bone cutter according to the teachings further described below.
[0018]
The removed bone blocks 330, 340 and 350 are generally formed into stoppers or dowels, and are preferably further machined by conventional methods known in the art. In one particular aspect, the dowel is machined to dimensions suitable for various surgical procedures. Machining is preferably performed on a graded die, grinding wheel, lathe, or in view of the teachings herein, the instrument for machining may be specifically designed and adapted for this purpose. . Preferred dimensions of the dowel include 8 mm, 9 mm, 10 mm, 11 mm and 12 mm in diameter. Product dimensional reproducibility is an important feature for the successful use of such implants in a clinical setting.
[0019]
In one particular aspect, the present invention is directed to a method of repairing a cruciate ligament injury including implantation of BTB. FIG. 4 illustrates this procedure, wherein holes 466 and 462 for receiving a BTB 430 including two bone blocks 432 and 434 connected by a tendon 433 are formed therein, respectively. The tibia 410 is shown. Suture 460 is selectively tied to bone block 432 to assist in guiding BTB 430 through hole 462, thereby allowing the surgeon to pull BTB 430 through hole 462 and subsequently remove suture 460. can do. Once BTB 430 is properly positioned in holes 462 and 466, BTB 430 is secured into recipient bone by interference screw 440. The interference screw 440 is preferably self-tapping and is rotationally mounted in the space between the grooves 438 and 436 and the holes 466 and 462, respectively. In one even more preferred embodiment, the BTB can be pre-marked for alignment. Placing such indicia on the BTB to assist the surgeon in viewing the depth of the BTB in the hole formed to accommodate the BTB and in viewing the rotation of the bone ligament junction and the BTB. Can be.
[0020]
Referring to FIGS. 5-7, another aspect of the present invention is shown directed to a BTB harvesting device, such as a core cutter 500, including a shaft 502 having a first end 503 and a second end 505. I have. The first end 503 of the shaft 502 preferably has a long axis 501 designed for drilling, such as by inserting a Jacob's chuck attached to an electric drill (eg, Dupuy). It is arranged in the direction. A second end 505 of the shaft 502 can be attached to a first end 512 of the hollow cylinder 504. The second end 514 of the cylinder 504 preferably has teeth 510 disposed thereon. In one preferred embodiment, the cylinder has at least one slot 506 on its surface that helps to remove the resected graft tissue from the core cutter 500. Slot 506 also provides a means of cleaning the implant during the extraction procedure, thereby reducing the chance of friction burning of the implant. In one preferred embodiment, the length of the shaft 502 is about 90 mm, the length of the cylinder 504 is about 50 mm, and the length of the slot 506 is about 30 mm. In one even more preferred embodiment, the first end of hollow cylinder 512 has a portion 522 that is chamfered at an angle toward axis 502.
[0021]
FIG. 6 shows an enlarged view of the core cutter teeth 510 as an example. The radius of tooth A and the rake angle of tooth B (also referred to as bottom angle) are appropriate values to avoid tooth failure (eg, bending or breaking) and unwanted damage to the implant. Is preferred. For example, FIG. 6A shows an unacceptable tooth pattern, where the radius A and the lower end angle B are too large, resulting in an insufficiently supported structure for the teeth, and a failure is inevitable. According to the present invention, a core cutter having a diameter of about 10-11 mm preferably has about 14 teeth, the radius A of the teeth is about 20-30 mm (preferably 25 mm) and the lower end angle B is about 10-10. Degrees to 20 degrees (preferably 15 degrees). For core cutters designed for smaller or larger bone blocks, it is preferable to reduce or increase the number of teeth as appropriate, while maintaining the above dimensions. In one preferred embodiment, each time the diameter of the cylinder decreases or increases by 10 mm to 11 mm by 1 mm, the number of teeth is respectively reduced or increased by two. For example, a core cutter having a cylinder diameter of 12 mm may preferably have about 16 teeth.
[0022]
FIG. 7 shows an enlarged view of the end portion (the circular portion shown in FIG. 5) of the cylinder 504, and the inside diameter (ID) is reduced by adding a relief thickness 520 to the inner surface of the cylinder 504. A preferred embodiment of the cylinder 504 is shown, which reduces to: This aspect provides additional convenience when using a sizing device (eg, a ring) to select an extracted bone block that is within the desired parameters. For example, the selection of a BTB with a 10 mm size measurement device would preferably require a BTB with a slightly smaller diameter than the measurement device, and any other small irregularities in the shape of the BTB would be desirable. Cannot pass through the measuring device. The relief thickness 520 reduces the ID of the cylinder 504, thereby achieving this slight modification to the BTB.
[0023]
FIG. 8 illustrates a further embodiment 800 of the BTB of the present invention that is particularly adapted for implantation during knee surgery, wherein implantation and fixation of the BTB is bidirectional. BTB embodiment 800 has one bone block portion 810 and one tendon portion 820. The preferred area for harvesting embodiment 800 may be the heel, thigh or shoulder. More preferably, embodiment 800 is taken from the heel or thigh, whereby tendon portion 820 is derived from the donor's Achilles or quadriceps tendon. Bone block portion 810 has two ends 812 and 814 that include tapered regions 816 and 818, respectively. The presence of the two tapered regions 812 and 814 allows for bi-directional insertion and fixation of the BTB aspect 800, such as the tibia 462 or femur described above in connection with the method illustrated in FIG. 466 means implantation into any hole. Of course, the implantation site can be approached from the point of entry above, i.e., a through hole is placed in the femur as opposed to the tibia. It is believed that the BTB embodiment 800 is suitable for securing to any hole in such an alternative procedure. Further, a bone block 810 having a groove 850 can be provided to assist in fixation of the implant. In addition, it may be desirable to have a means for manipulating the implant at the time of implantation, such as with sutures or implant insertion tools. Accordingly, BTB aspect 800 is provided with preformed graft manipulation holes 852 and 854 to accommodate sutures and / or graft insertion tools. In the illustration of the orientation of the graft manipulation holes, the graft manipulation holes 852 and 854 are shown to be perpendicular or parallel to the axis of the bone block 810, respectively. Preformed implant manipulation holes can be made by conventional methods such as drilling. Those skilled in the art will readily recognize suitable devices for insertion into preformed holes 852 and 854. Preferably, the implant insertion device used includes a distal end having a shape and size suitable for insertion into a graft manipulation hole.
[0024]
One of skill in the art will appreciate that the graft can be an autograft, an allograft or a xenograft. Xenograft implants may further require treatment to minimize the levels of antigenic and / or potential pathogenic agents present in the graft. Currently known or later developed techniques for preparing tissue suitable and non-rejectable for the recipient are incorporated herein. If the graft is an allograft or a xenograft, various infectious diseases and pathogens, including human immunodeficiency virus, cytomegalovirus, hepatitis B, hepatitis C and some other pathogens It is preferred to screen donors for These tests can be performed by any of a number of common means in the art, including but not limited to ELISA assays, PCR assays or hemagglutination tests. Such testing is in accordance with the requirements of the following organizations: (a) American Association of Tissue Banks, "Technical Manual for Tissue Banks, Technical Manual-Technical Manual for Tissue Banking, Technical Manual-Musculoskeletal Tissues ", pages M19-M20; (b) The United States Food and Drug Administration (The Food and Drug Administration)," Provisional Rules (Interim Rule) "," Federal Register (Federal Register), Federal Register (Federal Register). 58, no. 238, Tuesday, December 14, "Rules and Regulations" 65517, D.C. , "Infectious Disease Testing and Donor Screening"; (c) MMWR, Vol. 43, no. RR-8, "Guidelines for Presenting Transmission of Human Immunodeficiency Virus Throughthrough Translation of Human Tissue; Fourth Page d) Florida Administrative Weekly, Vol. 10, No. 34, August 21, 1992, 59A-1.001-014, 59A-1.005 (12) (c), F.C. A. C. , (12) (a)-(h), 59A-1.005 (15, FAC, (4) (a)-(8), in addition to a series of standard biochemical assays. To the donor or relatives to determine if the donor is a high-risk act, such as having a large number of sexual partners, suffering from hemophilia, or using intravenous drugs. A questionnaire to confirm can also be made, and if the donor is confirmed to be acceptable, the tissue for obtaining the BTB is collected and washed.
[0025]
The disclosures of all patents and publications cited throughout this specification are incorporated by reference in their entirety to the extent that they do not conflict with the disclosure herein.
[0026]
The examples and embodiments described herein are for the purpose of illustration only, and various modifications or changes will be suggested to those skilled in the art in light of the spirit and spirit of the present application. It should be understood that they fall within the scope as well as the scope of the appended claims.
[0027]
Example 1 : Crude for patella tendon / tibia donor BTB For harvesting
BTB was collected according to the following procedure:
[0028]
1.摘 Remove three layers of connective tissue from the front of the tendon using blunt and sharp incisions.
[0029]
2.切断 Use a scalpel or scissors to cut along the medial and lateral boundaries of the tendon. A blunt incision is made with scissors to separate the tendon from the fat layer.
[0030]
3.切断 Cut around the patella block and separate it from the proximal tibia and distal femur. If necessary, leave the patella with a quadriceps tendon attached to it. If the quadriceps tendon is not to be joined, the quadriceps is completely separated from the patella by a sharp incision.
[0031]
4.引 き 出 し Pull the tendon out of the capsule and remove any excess fat tissue for the tibia insertion point.
[0032]
5.横 Make a transverse cut on the rough surface of the tibia about 30 mm from the tendon insertion point using a saw. A similar cut is made about 5 mm proximal to the insertion point to remove the tibial plateau.
[0033]
6.て も Even if there is a tendon, cut the tibial block using a saw and align the surfaces.
[0034]
7.切削 Using a saw, cut three sides of the patella block to align the faces (if the quadriceps tendon is still attached, square only the medial and lateral sides).
[0035]
8.除去 Remove extraneous soft tissue and cartilage from patella, tibial tuberosity and tendon.
[0036]
9. 、 Use a scalpel to divide the tendon into medial and lateral halves to bisect the patella tendon. Each half requires 14 mm or more unless otherwise specified.
[0037]
10.分割 Divide the patella block and tibial block in half using a saw, following the same medial / lateral lines used to split the tendon.
[0038]
11.す る Rinse the bone block thoroughly with sterile water or saline.
[0039]
Example 2 : Procedure for forming a patella tendon with a preformed dowel for patella tendon / tibia donor
BTB was collected according to the following procedure:
[0040]
1.摘 Remove three layers of connective tissue from the front of the tendon using blunt and sharp incisions.
[0041]
2.切断 Use a scalpel or scissors to cut along the medial and lateral boundaries of the tendon. A blunt incision is made with scissors to separate the tendon from the fat layer.
[0042]
3.切断 Cut around the patella block and separate it from the proximal tibia and distal femur.
[0043]
4.引 き 出 し Pull the tendon out of the capsule and remove any excess adipose tissue for the tibia insertion point.
[0044]
5.横 Make a transverse cut on the rough surface of the tibia about 30 mm from the tendon insertion point using a saw. A similar cut is made immediately proximal to the insertion point to remove the tibial plateau. Another cut is made in the coronal plane 20-30 mm behind the insertion point.
[0045]
6. Align the tibial block with a saw.
[0046]
7.切削 Use a saw to cut three sides of the patella block and align the surfaces.
[0047]
8.取 り 付 け る Attach a vice to the top of the operating table. Place the tibial block in the vise and hold along the proximal and distal surfaces. The distal surface of the bone block faces the machine from which the tendons emerge. Tighten the vise as far as the bone will not break.
[0048]
9.装着 Attach a Jacob's chuck to the drill and insert a cutter of an appropriate size. Tighten the chuck with the chuck key. Note: At least two plugs should be cut from each bone block.
[0049]
10.配置 Place the cutter against the bone block so that the teeth of the cutter do not hit the tendon and graze just above the tendon. Position the cutter for maximum contact over the entire length of the bone plug.
[0050]
11.ス イ ッ チ Switch on the drill and start drilling the stopper. When the cutter approaches the end of the plug, slow down the drill until the cutter passes the proximal end of the bone block. Remove the plug from the cutter and drill to avoid damaging the tendon.
[0051]
12.段 階 Repeat steps 10 and 11 for the second stopper.
[0052]
13.腱 Divide the tendon into medial and lateral halves using scissors or a scalpel.
[0053]
14．し Remove excess bone from the operating table vise and place the patella block in the vise and hold along the proximal and distal surfaces of the block. The proximal surface of the bone block faces the processing machine, from which tendons can emerge. Tighten the vise as far as the bone will not break.
[0054]
15.段 階 Repeat steps 10 and 11 for both stoppers.
[0055]
16.と こ ろ で When the stopper is completed, remove the excess patella from the vise and remove the vise from the operating table.
[0056]
17.外 Remove the cutter from the Jacob chuck and attach a 1.5 mm drill bit to the chuck. Tighten the chuck key.
[0057]
18.切断 Use a saw to cut each stopper to a length of about 30 mm (not less than 25 mm).
[0058]
19.用 い Place the stopper therein using the Artrex clamp, flushing the end of the stopper with the end of the clamp. Place stopper before / after. Using the first guide hole closest to the end of the aligned plug, pierce the stopper with a 1.5 mm drill bit. Rotate the plug 180 degrees and place it inside / outside. The second guide hole is used to make a second hole through the stopper from the end of the aligned stopper.
[0059]
20.段 階 Repeat step 19 for all bone plugs.
[0060]
21.通 Pass each bone plug through an appropriate size gauge using a size measuring device. The entire BTB must pass easily. Trim as necessary.
[0061]
22.す る Rinse the bone plug thoroughly with sterile water or saline.
[Brief description of the drawings]
FIG. 1 shows an embodiment of a BTB having a groove having a thread-shaped cross section.
FIG. 2 shows a side view of three different embodiments of a BTB according to the invention.
FIG. 3 shows a front view of a donor region for collecting BTB in accordance with the teachings herein.
FIG. 4 illustrates another aspect of the present invention illustrating the reconstruction of an injured area by implantation of a BTB in accordance with the teachings herein.
FIG. 5 shows a side view of a BTB core cutter of the present invention designed to harvest a BTB implant.
FIG. 6A shows an enlarged view of a less desirable tooth morphology for use in accordance with the present invention. FIG. 6B shows an enlarged view of a preferred embodiment of the tooth of the embodiment shown in FIG.
FIG. 7 is an enlarged view of the circular area shown in FIG. 5;
FIG. 8 is a three-dimensional side view of a further embodiment of the BTB of the present invention including a single tapered block at both ends.

Claims (36)

Useful in orthopedic surgery, comprising one or more bone blocks and tendons attached to the one or more bone blocks, wherein the one or more bone blocks are shaped as dowels Bone-tendon-bone graft. 2. The bone-tendon-bone graft of claim 1, wherein the bone-tendon-bone graft comprises one bone block, wherein the tendon is derived from a donor's Achilles, patella or quadriceps tendon. 3. The bone-tendon-bone graft of claim 2, wherein one bone block includes a first end and a second end, wherein the first and second ends are tapered. 3. The bone-tendon-bone graft of claim 2, wherein one bone block includes a groove sufficient to receive a fixation screw. 3. The bone-tendon-bone graft of claim 2, wherein one bone block includes at least one graft manipulation hole. 2. The bone-tendon-bone graft of claim 1, wherein one or more bone blocks are cut to provide sufficient grooves to receive fixation screws. 2. The bone-tendon-bone graft of claim 1, wherein the one or more bone blocks have a diameter of 8 mm, 9 mm, 10 mm, 11 mm or 12 mm. 2. The bone-tendon-bone graft of claim 1, wherein the groove is a radius cut over the entire length of the bone block. The bone-tendon-bone graft according to claim 1, wherein the bone-tendon-bone graft has a thread profile on the surface of the groove of the bone block. The tendon has a first end and a second end, and one or more bone blocks have a first bone block associated with the first end and a second bone associated with the second end The bone-tendon-bone graft of claim 1, comprising a block. 11. The bone-tendon-bone graft of claim 10, wherein the first bone block is from a patella, the second bone block is from a tibia, and the tendon is from a patella tendon. The first bone plug and the second bone plug are continuous and overlap so that a groove is formed in the bone plug that is cut out later by cutting out the first bone plug or the second bone plug. A method of obtaining a plurality of bone-tendon-bone grafts, comprising the steps of:
a) severing a first bone plug with attached tendon from the bone; and b) severing a second bone plug with attached tendon from the bone. 13. The method of claim 12, wherein the cutting is accomplished by a core cutter or a punch. 13. The method of claim 12, wherein the bone is selected from the group consisting of patella, femur, calcaneus, and tibia. A method of performing orthopedic surgery on a human or animal, wherein at least one of the one or more bone blocks has a groove suitable for receiving a fixation screw,
A method comprising obtaining a bone-tendon-bone graft comprising a tendon having two ends and one or more bone blocks associated with the tendon. 16. The method of claim 15, further comprising the step of securing one or more bone blocks to one or more bones of the animal. 17. The method of claim 16, wherein the one or more bones of the animal are selected from the group consisting of patella, femur, calcaneus, and tibia. 16. The method of claim 15, wherein the one or more bone blocks are pre-formed as dowels. 18. The method according to claim 17, wherein the size of the diameter of the one or more bone blocks is selected from the group consisting of 8mm, 9mm, 10mm, 11mm and 12mm. 19. The method of claim 18, wherein the one or more bone blocks comprises two bone blocks of different sizes. A method of performing orthopedic surgery on a human or animal, wherein at least one of the one or more bone blocks is tapered,
A method comprising obtaining a bone-tendon-bone graft comprising a tendon having two ends and one or more bone blocks associated with the tendon. 22. The method of claim 21, wherein the bone-tendon-bone graft comprises one bone block and the tendon is from a donor's Achilles, patella or quadriceps tendon. 23. The method of claim 22, wherein one bone block includes a first end and a second end, wherein the first and second ends are tapered. 23. The method of claim 22, wherein one bone block includes at least one implant manipulation hole. 23. The method of claim 22, wherein one bone block includes a groove sufficient to accommodate an interference screw. 22. The method of claim 21, wherein the orthopedic surgery is a repair or replacement of the anterior or posterior cruciate ligament. 13. A bone-tendon-bone graft made by the method of claim 12. Bone-tendon useful in orthopedic surgery, comprising one or more bone blocks and a tendon associated with the one or more bone blocks, wherein at least one of the one or more bone blocks is tapered -Bone grafts. A tendon has a first end and a second end, one or more bone blocks associated with the first end and a second bone block associated with the second end 29. The bone-tendon-bone graft of claim 28, comprising: A first bone block and a second bone block have a first end contiguous with the tendon and a second end opposite the first end, wherein the first bone block is at a first end. 30. The bone-tendon-bone graft of claim 29, wherein the bone taper tapers and the second bone block tapers toward the second end. 31. The bone-tendon-bone graft of claim 30, wherein the first bone block and the second bone block each have sufficient grooves to receive fixation screws. A cylindrical portion having a shaft portion and a first end and a second end, wherein the first end is continuous with the shaft portion, the teeth are disposed at the second end, and the cylinder includes at least one slot. A device useful for the removal of bone-tendon-bone grafts. 33. The device of claim 32, wherein the tooth radius is between about 20mm and about 30mm. 34. The device of claim 33, wherein said radius is about 25mm. 33. The device of claim 32, wherein the rake angle of the teeth is between about 10 degrees and about 20 degrees. 36. The apparatus of claim 35, wherein said rake angle is about 15 degrees.

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